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Author
Topic: Is this Bad Science (Read 6597 times)

Knowing how American christians hate foreskin I find this hard to believe:Circumcision could prevent millions of AIDS cases in Africa: reportTue Jul 11, 5:42 PM ETPARIS (AFP) - The systematic circumcision of all boys in sub-Saharan Africa could potentially prevent nearly six million new HIV/ AIDS infections over the next two decades, a research team says in a published study.

The study, coordinated by Brian Williams of the World Health Organization (WHO) and published in the US review PLoS Medicine, is based on results of a trial conducted in South Africa, in which men were offered the chance to be circumcised. Those who chose to be circumcised had a lower HIV infection rate 18 months later.

Researchers say that their test shows a reduction in rates of infection, from women to men, of about 60 percent. Extrapolated mathematically, that would lead to a prevention of about two million new HIV infections in the next 10 years, and a further 3.7 million cases in the decade after that, while 2.7 million deaths could be prevented.

About a quarter of those numbers, both deaths and infections prevented, would occur in South Africa, they said.

The study builds on primary research led by co-author Bertran Auvert of France's Inserm medical research institute in the Orange Farm area of South Africa.

His group's work on 3,000 male cases provided a scientific demonstration of previous speculation that male circumcision could have an impact on the spread of AIDS, which is ravaging Africa.

Results from other trials in Uganda and Kenya are being gathered by the US National Institutes of Health (NIH), and are expected to be published in September 2007.

Some 38.6 million people are dealing with HIV or AIDS, some 24 million of them in Africa.

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"You shut your mouthhow can you sayI go about things the wrong wayI am human and I need to be lovedjust like everybody else does"The Smiths

I've read a similar report and must admit that the science is sound as far as I can tell. It would do well to help prevent HIV as long as the people getting it understand that it isn't the same as a condom. It provides SOME protection, a little less than half. It could backfire if people believed they were immune...

R

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NB. Any advice about HIV is given in addition to your own medical advice and not intended to replace it. You should never make clinical decisions based on what anyone says on the internet but rather check with your ID doctor first. Discussions from the internet are just that - Discussions. They may give you food for thought, but they should not direct you to do anything but fuel discussion.

I saw several reports that dismissed that study and many of the major medical periodicals refused to publish it for various reasons. One big issue is that the circumcised group was heavily counseled to NOT have sex for 6 weeks AND to ALWAYS use a condom (including teaching on how to use a condom). Who's to say that their lower rates of HIV incidence isn't simply due to detailed safer sex counseling and the demand that they use a condom for the first 6 weeks (after which they may be more likely to continue using condoms). The non-circumcised group didn't receive any counseling, nor were they told not to have sex (or at least always use a condom) for the first 6 weeks. The study had an efficacy rate of 60% (which doesn't seem that high).

My thoughts: South Africa has a high rate of circumcision and that doesn't seem to have provided that country with any significant protection against a high rate of HIV infections. I'm doubtful this will do much. Instead of focusing on circumcision, they should focus on safer sex messages/training.

Cliff, do you have a list of the periodicals that refused to publish the controversial study/studies? I'm very curious. Jay

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Her finely-touched spirit had still its fine issues, though they were not widely visible. Her full nature, like that river of which Cyrus broke the strength, spent itself in channels which had no great name on the earth. But the effect of her being on those around her was incalculably diffusive: for the growing good of the world is partly dependent on unhistoric acts; and that things are not so ill with you and me as they might have been, is half owing to the number who lived faithfully a hidden life, and rest in unvisited tombs.

Countries in which >80% of the men are circumcised have lower HIV prevalence than countries in which <20% of the men are circumcised.

This does not even begin to address the other potential explanations for the lower HIV prevalence. Certain societies routinely circumcise for religious reasons. Say for example, Muslim countries. Would anyone suggest that the only, or even most significant, reason why most Islamic nations have lower HIV rates is because they circumcise? This point does not allow for the fact that there are a whole host of reasons why certain countries have lower HIV infection rates. Because of that, this is very misleading.

Also is the US included in this stat? Doesn't the US have a very high rate of circumcision (like 75-80%)? Don't Americans also have a much higher rate of HIV infections, (and STDs in general), than say other developed nations/regions with very low rates of circumcision (say Europe)? If circumcision hasn't worked for the US, then perhaps researchers are overlooking the real problem?

Quote

Quinn suggested that as a public health measure safe circumcision should be made available now, and further data developed. In a model of the effect of circumcision, a 50% reduction in relative HIV acquisition risk would cut HIV incidence from 0.8 per 100 person years to 0.4 in women, in addition to the 50% protective effect in men.

Wild speculation and assumes HIV lives in a circumcised vacuum. It doesn't.

My issue here is that these studies don't take into consideration, nor respect, the cultural norms of other nations. These scientists come in with their mind solely on circumcision and want to turn all of the developing nations into little Americas, where all little boys are routinely circumcised, for no apparent medical reason other than looks. And yet there's no proof that when you consider the complete and total environment that results in HIV infections, (and HIV infection rates at a national level), circumcision may only play a very minor role (at most). If circumcision is the problem, then Europe would be in big trouble, since that continent probably has a lower rate of circumcision than Africa or North America.

It's not whether you're cut, but what you do that counts!

At a local (personal) level, it's sexual behaviour that impact HIV not the shape or size of your anatomy. At a national level, it's a host of reasons (cultural, poverty, access to good health care/information)

Anyways, why don't they also offer up female circumcision to counteract HIV? Why just focus on just the men? If mucousal (sp?) tissue is the problem, why not remove it from women and see if that helps prevent HIV?

Some of the evidence is a bit flaky, and it all got a good grilling at CROI, but the Uganda data (not South Africa though) was strong enough to convince several skeptical acitivsts that there was merit in the idea and it is worth further large-scale study. Clearly it is not the only factor at play. Condoms can be and on/off affair, but circumcision is usually on (or off I guess) permaently. This report summarises a meta-analysis by London School of Hygeine & Tropical Medicine.

From this report:

"Male circumcision is almost universally practised in most parts of west Africa, where the HIV prevalence is relatively low. Conversely, in eastern and southern Africa, where the HIV rate is much higher, many ethnic groups do not traditionally practise male circumcision.

"There is some evidence that male circumcision reduces the risk of ulcerative STIs, such as chancroid and syphilis. As STIs increase the chances of acquiring and transmitting HIV, it is likely that male circumcision has an indirect effect on HIV infection. It may also protect against HIV directly, as viral entry can occur through small lesions on the foreskin. The inner foreskin tissue contains a high density of immune cells that are targets for the virus.

"The meta-analysis includes studies from eight countries: Burkina Faso, Côte d’Ivoire, Kenya, Rwanda, Senegal, Tanzania, Uganda and Zambia. It assesses the effect of circumcision on male susceptibility but not the likelihood that men will infect their sexual partners. The results showed that:

"Risk of HIV is lower among circumcised men in 21 of the 27 studies.

Circumcision reduces the risk of HIV by around 50 percent.

The association is even stronger after adjustment for potential confounding factors, such as religion or prior or current genital ulcer disease and is strongest among men at high risk of HIV."

Just trying to lighten things a little (perhaps ill-advisedly), groan grunt grumph. As a member who's bathed in about 20 gyms across the world, I've had an opportunity to look at the cut and uncut. Most times in the UK and US. No surprising results: UK, mostly uncut, US, mostly cut (but that's prejudiced by where I've lived). Anyway, observational studies of this kind -- almost like Audobon with his birds -- should be encouraged. Discreet and non-cruisy. But let's assume they're of a quasi-official nature. Jay

« Last Edit: July 13, 2006, 05:35:10 PM by lydgate »

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Her finely-touched spirit had still its fine issues, though they were not widely visible. Her full nature, like that river of which Cyrus broke the strength, spent itself in channels which had no great name on the earth. But the effect of her being on those around her was incalculably diffusive: for the growing good of the world is partly dependent on unhistoric acts; and that things are not so ill with you and me as they might have been, is half owing to the number who lived faithfully a hidden life, and rest in unvisited tombs.

I'm not totally convinced either. My own partner is uncut and we were having unprotected for eighteen months before I knew my status - and he remains hiv negative. Like many couples, we were very active in the early days of our relationship but he didn't become positive, despite having a foreskin.

I know that one case doesn't prove anything, but I just don't see the 50% figure quoted as being accurate. Maybe I'm just being biased because I've never believed in circumcision and if I had any sons, I would not have had it done to them.

I also think that there should be more emphasis on condom use and less on foreskin. There is a very real danger of sending out the wrong message that cut men can get away without using condoms - and it also makes uncut men who have had a slip-up convinced they have become infected because they have a foreskin. We see this in the other forum quite often.

"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

interesting, certainly, but worth putting a whole heap of extra $ into? maybe, possibly, but perhaps akin to saying if we tore down all the golden-arched temples to convenience food, obesity'd be a past-tense issue....people are funny things - they only behave like statistics for so long. And what's happening to taking responsibility? Seems to be going rapidly out of fashion, like last year's mobile phones

I happen to fall in the "altered" (thanks Kate! ) category and all it took was one slip up for me to get infected. I feel those stats are flawed... and Kate you are right, people are not statistic beings...

I did a search for US hiv deaths (for another thread) and damn near all the results that came back were "circumcision to save millions." Damn these stupid scientists and their dumb, selfish studies. Now everyone is gonna go get cut and then run out and have unprotected sex thinking they now have HIV Kryptonite and we'll end up with a much worse epidemic.

They should execute these people who push these fad-of-the-month, let's cram our values down the developing world's throat cause they really aren't people anyway, studies. They should execute them using the electric chair, or maybe the gas chamber. Which ever produces the most pain or takes the longest to achieve the desired results. But not the needles, that's not inhumane enough.

Well Cliff. As a scientist in the HIV community I have already posted your concerns. Maybe I suggest you direct your hate at the media who are NOT scientists and do not know how to responsibly report such findings - for the VERY reason this scientist already said.

R

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NB. Any advice about HIV is given in addition to your own medical advice and not intended to replace it. You should never make clinical decisions based on what anyone says on the internet but rather check with your ID doctor first. Discussions from the internet are just that - Discussions. They may give you food for thought, but they should not direct you to do anything but fuel discussion.

If you took my message as a literal interpretation of my feelings about "scientists in the HIV community," then you aren't a very smart scientist, (if you're one at all). Plus, you aren't in the HIV community, for heaven sake you can't even use a real name....Lord knows we wouldn't want someone to mistake you for being diseased and dirty, right?

In any event, I appreciate the advice "R", but I think I'll just continue to direct my "hate" towards scientists who push circumcision or maybe just scientists in general, (damn those assholes who discovered Norvir, damn them all the hell). Maybe they all should be executed, starting with...

What evidence do you have that these scientists have an agenda? I've seen plenty of honest scientific studies dragged through the coals because of the way they were reported by the media. How do you know it wasn't the media reporting of the research. You have read the research paper, right? What was your interpretation.

HIV community : read HIV research community. I guess that means something different here.

NB. Any advice about HIV is given in addition to your own medical advice and not intended to replace it. You should never make clinical decisions based on what anyone says on the internet but rather check with your ID doctor first. Discussions from the internet are just that - Discussions. They may give you food for thought, but they should not direct you to do anything but fuel discussion.

Lord knows we wouldn't want someone to mistake you for being diseased and dirty, right?

You want to explain exactly what your problem is here? You think I don't use my name here because I fear association with HIV positive people, right? It's because I don't want unsolicited e-mails at work from people in the FEARS section.

R

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NB. Any advice about HIV is given in addition to your own medical advice and not intended to replace it. You should never make clinical decisions based on what anyone says on the internet but rather check with your ID doctor first. Discussions from the internet are just that - Discussions. They may give you food for thought, but they should not direct you to do anything but fuel discussion.

Oh don't go and get your panties in a wad! You are a part of whatever community you are a part of. And yes, it is all the media's fault, (you'd make a great Republican pollster). And you can use whatever name or letter you wish. There are no rules here. Me...I think I's gonna change my name to "W." I've always wanted to be a "W."

Sincererly youRs,

W

P.S.- I ain't buying that explanation of yours either, (why you use "R"). It's about as weak as a Hydrogen bond on a peptide structure. (Just a little humor, from one non-scientist in the HIV community, to....)

Fine with me if you don't buy it. You believe anything you like, even if you don't think I am a scientist. I'm not here to convince you of anything. You got evidence that it is the scientists fault then show it. Until then I'll not participate in any further discussion with you. I doubt you read the initial study before you went round asking for them to be hung.

R

« Last Edit: July 13, 2006, 06:57:35 PM by HIVworker »

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NB. Any advice about HIV is given in addition to your own medical advice and not intended to replace it. You should never make clinical decisions based on what anyone says on the internet but rather check with your ID doctor first. Discussions from the internet are just that - Discussions. They may give you food for thought, but they should not direct you to do anything but fuel discussion.

awwww, you really did get upset when I said that scientists who force circumcision on folks should be executed. I apologize. I really don't think scientists who have an affinity for discarded, bloody foreskin should be executed using the gas chamber or the electric chair. Honestly, I don't R. And it saddens me to no end that you would believe I actually seriously considered such a thing.

I'm sorry you took my message so seriously, it did have the word Kryptonite in it afterall. That's usually a dead give-away. Usually. Well unless you're Lex Luthor. Then of course, there's nothing more serious than Kryptonite. You're not Lex Luthor are you? Is that what the R is for?

But just so we are clear. I did NOT ask for them to be hung. Not once. Those were your words, not mine, mister. I wanted them electrocuted or gassed.

Regretfully yours,

W

P.S.- If you were looking for my serious thoughts on the subject, perhaps you should have read the entire thread, (from the top). Just a suggestion.

NB. Any advice about HIV is given in addition to your own medical advice and not intended to replace it. You should never make clinical decisions based on what anyone says on the internet but rather check with your ID doctor first. Discussions from the internet are just that - Discussions. They may give you food for thought, but they should not direct you to do anything but fuel discussion.

I am finding this an incredibly fascinating thread! Thanks , Cliff, I agree with you that scientists can use "statistics" all they want and try to prove a point but it dont make that point a valid one.I speak from some experience here: My father was a research scientist. And one of his colleges, during the early 60's, ACCEPTED a grant from the state of ( well known southern state) to prove that negroes were inferior physically or otherwise, inferior to whites. ( Based on anatomical statistics). I have NO idea what his paper was like but I'm sure he tried to make a case. Sooooooooo..... dont believe something just because a scientist said it!

one scientist, one report, one published piece of data does not, in my opinion, a consensus make. There have, however, been numerous reports linking HIv infection in developing nations to uncircumsized males. The science behind this lies in the economics of the nations, along with the discovery of dendritic cells inside the intact foreskin which, after circumsizion, become keratinized and rendered (not only less sensitive to sensation, but also) less receptive to pathogenic influence.

That's simply the science. Now, proper hygeine and training insofar as condom useage and the like can easily even out the odds. It escapes me why, instead of takign this science to indicate the necessity for more training insofar as condom useage and safer sex, we choose to advocate circumsition instead. it's a surgical procedure that would not be necessary had the USA not bullied the NIH and WHO into withholding condom information and distribution from the developing world community.

However, the science is pretty solid, and the notion of dendritic cells and HIv infection is the bedrock for much of our current HIv transmission vector information. Yex, circumsizing males can prevent a great number of HIV infections ... in the same way that performing hysterectomies on females can prevent pregnancies.

It's a surgical response to a societal crisis. Simple hygeine and condom education can accomplish the same thing.

As for the "scientists" thing, I leave that to the people who either reject science out of hand because of flaws in the process/politics, or submit that picking and choosing which science is valid based on our own agendas and prejudices is hardly an improvement in the process.

More to the point, HIVWorker has been and remains one of the strongest, most reliable and informative experts in the field to grace aidsmeds.com. I can certainly vouch for his credibility, and his participation here on the forums has been directly responsible for many of the re-examinations of HIv science that makes aidsmeds.com a profoundly current, dynamic resource.

« Last Edit: July 13, 2006, 10:26:37 PM by jkinatl2 »

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"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

quote: jkinatl: Yex, circumsizing males can prevent a great number of HIV infections ... in the same way that performing hysterectomies on femaler can prevent pregnancies..............................................Ouch!....I guess getting circumsized when you are twenty is pretty painful. So does this study recommend ADULT circumsizion?

From what I gather, the study simply states that uncircumsized males in developing countries have a significantly greater risk for HIV infection when having unprotected sex.

The thing most people seem to latch onto is the circumsized penis, and not the unprotected sex.

I submit that if effective and widespread condom distribution and ACCURATE sex education (along, of course, with teachign the correct hygiene for uncircumsized males) is implemented, that HIV rates would significantly drop. Yes, circumsizing males (infant and adult) would decrease HIV infection from female to male. However, such a gesture does NOTHING to decrease the infection rate from male to female.

Oddly, I find it a rather mysogenistic measure, in that it seeks to protect males from infection without commiserate protection for females. And while absolutely scientifically valid, it sidesteps the issue of condom use, which would render a males foreskin, or lack thereof, an irrelevant factor in the safer sex equation.

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"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

I am flattered by that post Jonathan and I am honored you think that way. I am a research scientist and I don't believe it is all smoke and mirrors. As JK says one swallow doesn't make a summer. One study doesn't lead to a cure or proof that black people are stupid (sadly I can believe someone was stupid enough to get that racism funded).

People sometimes don't think I am a scientist, which honestly is fine. I don't know why. I really don't care. Maybe it is because they think a scientist wouldn't come on a forum and discuss the illness with people who have it? Maybe I can't interpret the motivation behind the written word without the help of smilies? Who knows. Maybe I'm just a dick sometimes.

I don't give medical advice on this forum about what meds to take. That's not my place. I never will. That's a decision for you and your doctor. I can only help interpret the science-babble. I'll continue to do that until asked not to.

R

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NB. Any advice about HIV is given in addition to your own medical advice and not intended to replace it. You should never make clinical decisions based on what anyone says on the internet but rather check with your ID doctor first. Discussions from the internet are just that - Discussions. They may give you food for thought, but they should not direct you to do anything but fuel discussion.

Note: these are not all, nor even most, direct links to first tiered peer reviewed articles. However, in many cases, they reference the journals and data from which they derive their assumptions.

If we are to believe that the presence of langhoreans cells indicates a greater susceptibility for HIV infection, then we must acknowledge the greater susceptibility of uncircumsized males insofar as HIV infection is concerned.

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"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

I think this is a bit of not seeing the forest for the trees. The issue is not the "science" of HIV infections, which really isn't all that solid as one would have you believe (or else they wouldn't be recommending more studies/clinical trials). I don't, (nor do most people), dispute the reasons why ON PAPER an uncircumcised penis would offer less protection than a circumcised one. My issue is:

1. There is no evidence that circumcision would actually impact the epidemic at a national level (which is much more dynamic than looking at Langerhans cells on a penis). Too much of the evidence doesn't take into account other explanations for explosive HIV infection rates. For example, the quote above (from Ibase) that those nations that circumcise at rates greater than 80% have lower HIV infection rates than those that circumcise at rates less than 20%. A significant majority of those nations (those whom circumcise greater than 80%) are very repressive, Islamic regimes. What impact does a repressive, Islamic society have on HIV infections? Does that have a much greater impact than their rate of circumcision? How do we even know the actual HIV infection rate, when much of it is hidden and repressed?

2. Circumcision in many parts of the world is a cultural matter. These scientist, (those who make actual recommendations), often never take this into account. In South Africa, the Xhosas routinely circumcise, while the Zulus don't. There is a specific reason why they either do or don't circumcise and you can't just plop down like Moses and tell everyone to just circumcise, simply because we "believe" it will help the epidemic. Circumcision isn't just a matter of science. This is a very American way of looking at the issue. Oh, circumcision is no big deal in my country, so let's just thrust it on everyone else...surely everyone else doesn't consider it a big deal either.

3. Circumcision fails to explain why Europe's epidemic is so low and why the US is so high. Personally, I would need to know why this "science" breaksdown for the US and Europe. And please don't say for hygienic reasons, cause that's not true (and really it's just a typical American-based stereotype that all circumcised penises are dirty)....it doesn't take much to clean an uncircumcised penis and folks poor and rich can (and do) easily clean themselves. Actually I would wanna know why this science also "breaksdown" for South Africa, which compared to its neighbors (and most developing nations), has a higher circumcision rate, and yet that nation still has the highest burden of HIV disease than any other. And why does it break down for countries like Brazil, who despite having a low rate of circumcision and the potential for an explosive HIV infection, doesn't? What did Brazil do that was MUCH more effective than going around cutting up all the penises in the nation? Perhaps people should look to that country and not to circumcision as a potential solution.

4. The science doesn't consider potential negative implications. What does it tell people when you say you should get circumcised to protect yourself from HIV? It tells them that it's okay to have unprotected sex, if you're circumcised. Could this not actually make the epidemic worse and actually cancel out any benefit gained from circumcision? Has anyone studied this potential negative impact, before making policy recommendations? What about the impact that people will most likely start having home-made circumcision (in non-sterile environments), as they do now in most places where circumcision is common. Before making policy recommendations, have they considered the number of lives that will be lost and HIV infections that will take place, because of this? Will this too help to cancel out any benefit?

To me there are other more reliable methods of reducing HIV infections that are much more economical, safer, culturally sensitive and already known to be more effective than circumcision. This circumcision bit is culturally insensitive and really just another HIV science fad, that people, (scientists and the media), seem to harp onto because it's a novel idea, without really considering how it will impact those they plan on thrusting their beliefs onto.

As a I said before, it's not what your penis looks like that really matters, it's what you do with it!

Whatever the reasons, I've acted like a fool on these forums lately. I don't want to labor you with reasons as there are no excuses.

Just know that I know I have to just chill out.

R

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NB. Any advice about HIV is given in addition to your own medical advice and not intended to replace it. You should never make clinical decisions based on what anyone says on the internet but rather check with your ID doctor first. Discussions from the internet are just that - Discussions. They may give you food for thought, but they should not direct you to do anything but fuel discussion.

along with the discovery of dendritic cells inside the intact foreskin which, after circumsizion, become keratinized and rendered (not only less sensitive to sensation, but also) less receptive to pathogenic influence.

So boiled down is this saying that the virus can enter through (fore)skin.Much like the skin creams with vitamins- I thought the virus could not enter that way?From Cliff's post:

The issue is not the "science" of HIV infections, which really isn't all that solid as one would have you believe (or else they wouldn't be recommending more studies/clinical trials). Many of the fundings here in America are going on to promote the christian rights'agenda such as this report.

My problem is money that could be used for drugs or real science is going out to studies like this and those abstinence rings- who is funding that? How much money was spent? What proof is there because a teen ager makes a vow they keep it? What gets me is that with the slashing of funds or not keeping them in line with inflation, it is going to all this phoney science. Here in NYC ther is a christian tv station and except for saying the world is flat their science bits are so middle ages. This is as bad as the museums st up to show dinosaurs and man co-habited the planet till the rains cameCheersJohnny

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"You shut your mouthhow can you sayI go about things the wrong wayI am human and I need to be lovedjust like everybody else does"The Smiths

"The investigators reported 69 infections overall: 18 in the intervention group (2, 7 and 9 at months 3, 12 and 21 respectively) and 51 in the control group (11, 22 and 36 at months 3, 12 and 21 respectively)."

11+22+36=69 (not 51)

Also, do you have a breakdown of how many individuals were in the control group vs. intervention group?